The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, April 30, 2008

Enough Already!

I have stayed mostly quiet on the topic of the Macleans article that hit newsstands in January. It examined the doctor shortage across Canada, gave tips on how to find a family doctor, and looked in particular at the shortages in rural areas. Sprinkled liberally with anecdotes and horror stories, it was intended to sell magazines. It caught my attention, and the Bean and I took a trip to our local Chapters to peruse the article in question over a Starbucks Soy Chai (the Bean is sensitive to dairy). 

It was just another verse of the same song. I've complained about it before. And now other people are complaining about it too. The backlash from the article was heard across the country. Blaming female physicians for the doctor shortage is misguided. Now I know that the plural of anecdote isn't data, but I don't know of ANY female physician throwing it all away to spend more time with her children. But that might be because I don't know many female physicians who are married to male physicians. In the real world, income usually wins out over traditional gender roles. If Mom's income potential is $200K and Dad's income potential is $80K, if one of them is staying home with the kids it sure as hell isn't going to be the one who gave birth to them. Particularly not with med school debt to pay off.

I've said it before and I'll say it again... louder this time, for those of you in the back.


Physicians just aren't like that anymore. Gone are the days of the kindly old doc who has a family practice, delivers babies, does shifts in the emerg, cares for his inpatients in the hospital, does house calls, visits the nursing home, and does coroner call on the weekends. You know the type... known to everyone in the community but a stranger to his own family? Men have wised up. That's not a life. No one ever lay on their deathbed and wished they'd spent more time at work. The popularity of 'lifestyle specialties' is a testament to this. For the past few years, there have been spots left over after the match in specialties like general surgery, orthopedic surgery... hell, even neurosurgery hasn't filled in the first round. At the same time, the popularity of anesthesia, radiology and emergency medicine have gone through the roof. It seems that the only surgical specialties that are still uber-competitive to get into are the ones that offer a reasonable lifestyle on top of the hefty paycheque-- like ENT and plastics. 

Family doctors as a whole are setting up sustainable practices. That means picking a practice structure (FHT or FHN) that lets you leave work behind at the end of the day. That means less call. That means building a practice that won't leave young physicians burned out in 10 years. That means having a life outside of medicine. Imagine the nerve of these young physicians, trying to have it all! Since more women are entering medicine, it MUST be their fault!

Ask any of the old-school docs nearing retirement. They'll back me up. It's not just women. It's ALL new doctors. We're soft. We didn't train as hard as they did-- we didn't have to live in the hospital, we were allowed to be married. We got days off. We're paid. Our residency is shorter. We are protected by a union that enforces the rules and keeps us from being used as slave labour. We aren't willing to be on call. We protect our leisure time with the ferocity of a rabid dog. We don't want to work more than 60 hours a week. How dare we.

Why complain about it? The evolution of medicine has been positive in many respects. We aren't paternalistic, and medical decisions are now made with the patient calling the shots. We listen. We consider more than just the illness (in family medicine, anyway) but the social context. We have lives outside of medicine, and protect the longevity of our careers by not working to the point of suicide or burnout. We make a decent living, but are more likely to choose a smaller paycheque in order to work fewer hours. And what's the harm to the system? Well, maybe we'll need a few more doctors. We've seen that coming for years. And those doctors will be better people for the choices they've made... none of which can be attributed solely to gender.


Anonymous Anonymous said...

I'm so proud of you.


3:25 PM

Blogger med neophyte said...

Absolutely! Great points.

I would also point out that, when new doctors are talking about having a balanced life or a reasonable work schedule, they mean working 50-60 hours a week rather than 70-80; they mean being on call (a concept almost completely foreign to people outside of medicine) a few times a month rather than a few times a week; they are talking about having vacation, ever.

In most cases doctors are asking for a life that would still be called workaholic in any other field. They aren't asking for the world.

11:52 PM

Anonymous Anonymous said...

Excellent post!

As a dual physician couple with a little one on the way, it's not going to be easy, that is for sure. I hope to take 6 months off, and then hubby will take 2 off when I go back to work. Whatever will the hospital do without me for 6 months! Horrors! ;)

-Posting as Anonymous to protect my early-T1-preggers self!

1:15 AM

Blogger Couz said...

Now I'm dying of curiosity. I only know of two MD-MD couples in real life, and one of them is in her second trimester. The other is my best friend, and I'd BETTER know the second she's pregnant.

Do I know you?

8:10 AM

Blogger Behr said...

hear hear!

i've heard seniors make the same complaints - young docs daring to wish for a personal life and not wanting to be exploited during residency - but forgetting that the care that we offer is so much better than the paternalistic guesswork of the "old" days.
love your blog!

--behr (ER resident, brussels)

10:46 AM

Anonymous Anonymous said...

Hee. If you're thinking me, I am SOOOOOOOO not preggo. You would be first to know (outside o' Dr. J natch)


4:18 PM

Blogger Liana said...

Absolutely... it's that our entire generation of doctors (male and female) are "lazy" or "sane", depending on your point of view.

That video I linked on my blog awhile ago mentioned that 30% of the workload in Canada is done by doctors over the age of 50. Eep.

I'm intrigued by the comments... thought maybe it was a certain anesthesiologist I went to undergrad with but I guess not!

4:37 PM

Anonymous Anonymous said...

Indeed, I only know you (and Liana) through the blog-o-sphere!

I'm a good friend of the blogger-formerly-posting-as-"a-girl", and a few of my friends read your blog so I didn't want to let the secret out to all!

Love reading both your blogs though!

12:04 AM

Blogger Couz said...

Oh my God, L... now I know who you're talking about! I totally forgot about the doctor couple we both know and love in the north!

Guess it's not her either, though. ;-p

8:09 AM

Blogger Doctor S. said...

That was another great post! I can remember the chief of surgery at our medical school getting on the case of the chief resident because he was going to have some time off for the birth of his first child. He said, "In my day..." they didn't even accept surgery residents who were married - can't have the distraction! So you had to be an unmarried male because you would not have time to have babies and you wouldn't have a life anyway. I'm certainly going to demand a good lifestyle (finishing residency this year). It's true- no one ever looked back on life and wish they worked more. No kids wished their parents spent LESS time with them and worked for more money. Being a workaholic is STUPID.

10:08 AM

Anonymous Anonymous said...

So true! I am a surgeon and can make about 200,000 per year, my husband is a veterinarian and makes maybe about 80K per year, guess who stayed home for 8 years to raise our kids?

1:04 PM

Blogger Lisa b said...

Couz I totally agree with you that it is the profession as a whole and indeed our whole generation that has taken a more sane approach to work/life balance.
That said as a mom of a child who was hospitalized in a teaching hospital for three months last year it would have made a big difference to me to feel that most of the doctors I dealt with were not just trying to get done and back to their life.
I am sure though that comments made by some staff doctors that residents were not in early enough certainly did have an effect of my perception of their commitment.

2:07 PM

Blogger Shannon said...

Ha, I heard this on the radio a couple of months ago and was going to ask you about it, then I totally forgot. They were discussing the current difficulties in finding family doctors and the interviewer was asking what the reason is behind the "shortage", and the speaker's answer was exactly that: Family docs just aren't working 80 hour weeks with 1/2 call anymore. They refuse, and I can't blame them. There's the same number of doctors, they just aren't putting in the same breakneck hours.

It does lead to a question, though. If the docs are working less hours, surely there are less hours being billed.. so why not train more docs to fill the gap? Theoretically it shouldn't cost any more money, should it? (this being me who knows jack shit about how doc's hours are billed...)

9:43 PM

Blogger Dragonfly said...

So true. Thanks for posting such a great reply to the haters out there.

12:00 AM

Anonymous Dr.JaneDoe said...

Lisa B, while I sympathise with your son's illness, it is a bit strange that just because doctors now HAVE a life (a bit anyway) that you would think that that is all they want to do all day, get back to their "life" and out of work. when you're at work, you're working, unless you're being exploited and treated badly, you aren't usually wishing you were somewhere else, you're doing your job.
"I am sure though that comments made by some staff doctors that residents were not in early enough certainly did have an effect of my perception of their commitment."

I'm not too sure what you mean by that, do you mean that they were arriving for work later than their designated start time? If so, then I understand your views. However, if they were just rostered to start later than in the bad old days and staff were griping about it, then that is no reflection on their commitment at all! It is however, a reflection on the staff that made the comments, as they should not have done so, it is both morale destroying for the docs and leads to an unjustified lack of confidence in patient care for patients and relatives.

8:46 PM

Anonymous Dr.JaneDoe said...

what I'm trying to say is: if you require that docs should be in at all hours, work 24/7 and care about nothing other than work in order for you to have confidence in their abilities, then you need to revise your opinion. It's not safe for them or you to do that, and it's not healthy for people to have nothing in their lives other than medicine-and if the doc isn't healthy it leads to worse patient care. The public will have to get over these misconceptions. I have confidence in my GP, she works parttime and I saw her at the beach with her kids one day. It did not alter my opinion of her one bit and I kind of can't understand why it would. I have confidence in my lawyer, and I see him socially sometimes. It doesn't bother me that he goes out for a drink and has friends. He does a good job when he's working. Don't mean to rant at you, but it's something I feel quite strongly about.

8:51 PM

Blogger Shannon said...

You'll find this interesting...

12:37 PM

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3:52 AM

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3:30 AM


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